Digestive Enzymes

[Daniel]

Hey @R-S,

Love how thoughtfully you’re approaching this! You’ve already removed a few variables (slippery elm), started soothing the lining (aloe, Iberogast), and you’re timing thyroid support to real data. That kind of step-by-step tinkering is exactly what will help you to calm your sensitive guts down.

You might not know me yet. My name is Daniel. I’m a functional medicine practitioner as well, and I help Bernadette out on the forum. I know I’m stepping into a discussion that is bigger than this post alone. As I’m writing, I realise I might not have the entire picture complete yet, since quite a few posts have been written about stuff already. That being said, here is what I think about digestive enzymes in your mix, given you suspect IBS/SIBO, mild gastrotis and possible histamine issues, while you’re still on duloxetine:

• Yes, you can trial enzymes now: choose a gentle, broad-spectrum blend without betaine HCl.
• Start low, take them with food, and adjust the dosage by symptoms.
• Pause if you feel burning/pressure (especially with protein-heavy meals) or if upper-abdominal pain worsens.
• Keep Iberogast short-term and dose-limited; pair lining-support (aloe, ± DGL or zinc-carnosine) to help gastritis heal even while on duloxetine.

Why enzymes may help you:

• Since you suspect IBS/SIBO: partial carb/fat/protein mal-digestion can feed gas and bloat upstream; enzymes reduce the “substrate” that reaches bacteria.
• Histamine-sensitivity: enzymes don’t lower histamine directly, but better digestion lowers “trigger load” (less fermentation, fewer mast-cell nudges).
• Gastritis: be careful when using. Always “sandwich” your enzymes with food(eat half your meal first -> then take your enzymes -> eat the rest of your meal) and don’t add acid. Enzymes can, however, ease the workload without irritating the lining.

What to choose (and what to avoid):

• Search for a supplement with a broad blend. A blend with amylase, proteases, lipase, plus brush-border helpers like lactase and alpha-galactosidase, for example, would be my first pick
• No betaine HCl and no large doses of spicy bitters inside the capsule.
• No prebiotics (inulin/FOS) in the formula.

Products that fit these recommendations are, for example, Enzymedica Digest Gold® with ATPro and Pure Encapsulations Digestive Enzymes Ultra. If histamine is a clear trigger (flushing, headaches after aged foods), you can optionally add a DAO capsule before histamine richer meals. It doesn’t fix root causes; it just buys tolerance during the healing phase. But preventing histamine rich foods would always be better.

How to use enzymes safely:

1. Like I mentioned earlier, “sandwich” the enzymes in foods. Eat half your meal first, take the enzymes and then eat the next half of your meal
2. Start low and slow: consider starting with half a capsule of if you are really sensitive, start with 1/4 capsule. Keep the dosage the same for a few days to see how your body reacts
3. If a meal still feels heavy/bloated, increase the dosage
4. Stop or adjust if you feel a burning sensation under the sternum, gnawing pain, nausea, or diarrhea shows up.
5. Space with your meds: keep 2–3 hours away from your thyroid med once you start that, and at least 1 hour away from supplements like iron. Pancreatic enzymes can decrease the absorption of iron supplements. There is no special spacing needed from duloxetine.

Specific precautions for your case:

• Mild gastritis: Keep enzymes strictly with food and I can’t stress this enough: no HCl containing products!
• Allergies: avoid fruit-derived proteases if you react to pineapple/papaya. Bromelain is often derived from these fruits and it would be best to avoid it in this case.

Other considerations in your current plan:
Digestive bitters (from Mercola for example) are helpful for motility, but bitters can sometimes flare histamine since they sometimes contain citrus fruits. They also stimulate gastric acid production and can therefore worsen gastritis symptoms. Try micro-doses (1–2 drops) and don’t use them yet if you are testing the enzymes, so you can understand what supplement does what.

Can you heal gastritis while you’re on duloxetine?

I can’t really advise you on what you should do with your medication since I don’t have all the details. However, even with Duloxetine, you can initiate the gut healing process. Duloxetine can irritate the gut in some people, but lining repair still happens if you lower irritants and support the mucosa. What helps most:

• Give the gut lining support: The general recommendation to support healing of the gut lining is 75 mg zinc-carnosine daily (if you are already using zinc, this dosage should be adjusted accordingly), Aloe inner gel as you’re doing and DGL (deglycyrrhizinated licorice) could help. Avoid whole-licorice if you have high blood pressure.
• Food hygiene: warm, simple meals; avoid alcohol, NSAIDs, smoking; limit coffee on an empty stomach; smaller, more frequent meals during flares.
• Rule out H. Pylori if you haven’t done that already.
• Prioritise stuff that reduces stress: breath work, light walks after meals; these matter for gastric blood flow and motility

Here is a simple step by step plan:

Week 1: Keep aloe + Iberogast. Pair it with zinc-carnosine/DGL. Add a gentle enzyme at ¼–½ cap with lunch/dinner only. Track: fullness, belching, bloat, stool form.

Week 2: If tolerated, use with all main meals. Consider tiny-dose bitters or hold them if you are uncertain about histamine.

Week 3: If meals feel lighter but histamine-type reactions persist, consider a DAO trial before high-histamine foods while continuing lining support.

You’re doing a great job listening to your body and making smart, small moves. Keep that pace!

I hope this answer helps you as well

Daniel

• This reply was modified 1 week, 5 days ago by  Daniel.

[R-S]

Good morning Daniel

Nice to virtually meet you 😃

Thank you so much for your thoughtful reply, I really appreciate the time and detail you put into this. I am still navigating things step by step after some time of calming my system down, mentally and physically so I am being extra cautious with adding anything new.

At the moment, I am looking at adding Aloe Vera as a gut healing therapy after stopping Slippery Elm, and as I mentioned also considering adding digestive bitters and digestive enzymes.

From your message, I understood I should also add Zinc carnosine and DGL as well (will add them to the order- Seeking health for Zinc and Nature’s Way chewables?- hope these are okay). In terms of additions, I will definitely add one at a time gradually to track what really helps. I am following the food hygiene protocol and I don’t do any of the rest besides my Duloxetine, I have also ruled out H. pylori as well. My selenium result is back at 79.4 ug/L reference limit, 50-120, wondering is this sufficient to add Selenium for thyroid support. None of the items are available so I will be ordering all, so I haven’t started anything yet before confirming that I am taking the correct steps towards a proper healing plan.

Regarding histamine, I don’t really experience the classic histamine symptoms, though I know the overlap with gut issues can be tricky. I am also overly sensitive to smells and have generally never tolerated antihistamines. I will get Dr Mercola to test and also ginger is what I have been using at home- but could also get ginger root tincture as a safe option? I will get Enzymedica Digest Gold with AtPro. Your explanation about enzymes helping with SIBO and gastritis by lowering the substrate load makes sense to me, and I will keep the sandwich method in mind with cautious dosing.

From what you shared, it sounds like Aloe, Iberogast, Zinc carnosine, DGL and enzymes should come before bitters, which confuses me as per my discussion with Bernadette I am meant to start with bitters first.

I will order all of the above once I get confirmation regarding Selenium and would like to know which is the safest starting point from all these supplements to begin with first, second and so forth please.

I also appreciate the week by week outline you gave as it helps me see a clear structure, and I will pace things carefully. I will also continue with gentle walks and calming practices around meals as you suggested.

Thank you

[Daniel]

Hey @R-S ,

Welcome to the community! 🙂

First things first: trust Bernadette’s sequence.
She’s read the other posts posted by you, I’m still catching up. If Bernadette recommended you to start with bitters first, let’s keep that as the north star. My earlier note was only a caution that, with gastritis, a “low and slow” start is usually a safe bet (micro-dose, with food, pause if there’s burning) if an ulcer were present.

How my suggestion fits the bigger picture

In functional medicine, we often go:

1. Remove stressors → 2) Replace (enzymes, bile, etc.) → 3) Repair the lining → 4) Rebalance.
   Because you’re on duloxetine (which can be a gut stressor for some) and may not change that right now, I wanted you to know you can still repair the lining in parallel if you like. That’s why I mentioned zinc-carnosine/DGL as options, not must-haves today.

Keep the plan simple
If you tend to react strongly to supplements, start with fewer, not more. You can absolutely begin with bitters only at tiny doses with meals, and watch your stomach’s response. If that goes well, add enzymes later to lighten digestion. Zinc-carnosine and DGL can wait until you feel ready, or skip them if you’re improving without them.

Last but not least: You’re not alone!

No need to feel overwhelmed: we’ll help you pace it and adjust. One change at a time, listen to your body, and we’ll steer with Bernadette’s plan as the anchor.

You’ve got this!

• This reply was modified 1 week, 2 days ago by  Daniel.

[R-S]

Good morning Daniel,

Thank you so much for the reassurance and for clarifying how your suggestions fit into the bigger picture, that really helps me understand the sequence better.

I’ll definitely keep Bernadette’s plan as my anchor and start with the bitters first, very slowly and with meals as you both recommended. Once I see how my system responds, I can then move on to adding the enzymes, and later consider zinc-carnosine and DGL if needed as well as thyroid support once I get a confirmation from Bernadette on my Selenium results, would love to know what you think as well.

I really appreciate you emphasizing simplicity and pacing, it takes some pressure off and helps me feel more grounded in the process, really excited to get my treatment plan going soon, it has been great to get all this support and love being part of this community. Slowly and smoothly will get there eventually.

Thank you both for the guidance and support through this.